Posts Tagged Game

Imagine being in pain, but happily distracted from your suffering by being totally immersed in floating lazily down a river or tossing fish to hungry otters that pop up out of nowhere. Such scenarios of a 360-degree world are possible via virtual reality (VR), whereby a patient sits in a chair wearing a head visor connected to a computer and holds a small wireless device in his or her hand to change direction.

“Although [VR] is very early in its inception for treating painful conditions, we are hopeful that VR will interest other research and payors,” said James Choo, MD, owner and medical director of Pain Consultants of East Tennessee, in Knoxville, which conducted two clinical studies of VR. “I think there is a lot of potential for VR, especially if you marry VR to other pain treatments that are not widely available but that we know work, such as cognitive-behavioral therapy and mindfulness meditation for lower back pain.”

However, he added that few pain psychologists are practicing in the United States, and cognitive-behavioral therapy is time-consuming. “We have never had scalable treatments that work and that can be highly disseminated,” Dr. Choo said. “With VR, if you have the right software, there is an enormous potential to disseminate that type of care to millions of people rather than just a handful of patients who have access to the one pain psychologist that might be in their region.”

Similarly, mindfulness-based instruction through VR may be plausible.

“The effects of the type of VR program that we used derive from a game,” Dr. Choo said. “It is not just a passive immersive experience of looking around at the scene. You are actually playing a game—interacting with the environment itself. Besides distracting pain, VR is fun, like playing a video game.”

Dr. Choo said the immersive experience of being in a virtual environment and simply being distracted from pain are helpful. In addition, “perhaps even the immersive experience has its own analgesic effect,” he said. “But we do not understand quite yet the neuropathways that are being affected that cause the analgesic effect. Once we do, then we will be able to better target the type of VR programs that best suit the patient and their particular pain needs.”

Ted Jones, PhD, a clinical psychologist at Pain Consultants of East Tennessee, heard a conference speaker last year refer to VR as a syringe, meaning its effect “depends on the content.” He added, “Historically, since the late 1980s, VR has been used for procedural pain—basically for burn pain and injections in an inpatient setting or a burn unit. However, the majority of pain [treated by clinicians] is outpatient pain. So we are taking what has been used for inpatient procedural pain and using it for outpatient pain.”

To date, VR treatments at the clinic have been isolated to two completed studies, using software called Cool! developed by Firsthand Technology.

“What we have found is that if you give someone doses of VR, it cuts their pain dramatically,” said Dr. Jones, who was principal investigator of both trials. “However, there is no [long-term] effect. A week later, the patient is right back where he or she started, both painwise and depression-wise and stresswise. It is similar to a person coming to a pain clinic, giving them a dose of medicine and sending them home.”

The first study, conducted in 2015 and published last year in PLOSONE (2016;11:e0167523), consisted of 30 patients with chronic pain. Participants were asked about their pain before and after a single, five-minute session of VR conducted at the clinic.

“The study decreased pain by 55% to 60%,” Dr. Jones said. “VR is like distractionon steroids, because when your brain is in a virtual world, it is like you are there. In comparison, morphine reduces pain by only one-third.”

The second study, performed last year at the clinic, involved 10 patients with neuropathic pain. The protocol was three sessions of VR, each lasting 20 minutes and spaced one week apart.

“Pain was cut by roughly 70%, due to the longer exposure sessions and multiple treatments,” Dr. Jones said. “There was also a lingering effect. Most patients reported that their pain continued to be less for about one day on average after each session.”

‘Still Out of Reach’

However, depression, anxiety, beliefs about pain and how to cope with pain did not change over time. “In other words, VR did not provide patients any emotional or cognitive benefit,” Dr. Jones said.

Dr. Jones said a single VR unit costs between $3,000 and $4,000. Although it’s a dramatic drop from the previous $8,000 cost, “it is still out of reach for most patients,” he said. “Further, many of the units currently available have a lot of wires and require a high-end machine. You cannot take it home with you—physically or financially.”

To address these shortcomings, Pain Consultants of East Tennessee and the University of Tennessee plan on conducting a pilot study of 10 to 20 patients this fall with the portable Samsung Gear VR, which has an easy-to-use headset and some pain and relaxation applications, along with a Fitbit fitness mobile device to detect activity level and record pain.

“We will determine if daily VR home use is effective, which should be the case, based on our two previous studies,” Dr. Jones said. “Using VR at home several times a day is like being prescribed a pain reliever to be taken two or three times daily. VR has the chance to replace as-needed pain medicine at home.”

The occupational therapy department at the pain clinic is also scheduled to incorporate VR into therapy for conditions such as phantom limb pain and stroke pain. “For this application, VR acts like a mirror, so patients can see and restore movement,” Dr. Jones said.

Despite enthusiasm about VR for pain, there are several hurdles and challenges to make the modality effective in the clinical space. Besides no payors yet, “we need more in-depth studies to show its efficacy for [specific] conditions,” Dr. Choo said.

Apart from employing VR as simply a game, VR may be used as a substitute therapist in certain cases, or for biometric functioning and rehabilitation. “These are completely different programs,” Dr. Choo said. “Therefore, we have to be very specific on the types of software programs we use and the way they deliver care.”

For instance, VR could be used to help patients meditate or provide biofeedback.

“One of the key [goals] is for VR to become a scalable model,” Dr. Choo said. “The unit we are using is not portable. But in the future, we envision all VR units being extremely portable, easy to use and accessible.”

Dr. Jones added, “VR has a lot of potential. We just need to match it to the right patient at the correct setting and the right cost.”

Neurological and chronic diseases have profound impacts on a person’s life. Rehabilitation is essential in order to maintain and promote maximal level of recovery by pushing the bounds of physical, emotional and cognitive impairments. However, due to the low physical mobility and poor overall condition of many patients, traveling back and forth to doctors, nurses and rehabilitation centers can be exhausting tasks. In this thesis a game-based rehabilitation platform for home usage, supporting stroke and COPD rehabilitation is presented. The main goal is to make rehabilitation more enjoyable, individualized and easily accessible for the patients.

The game-based rehabilitation tool consists of three systems with integrated components: the caregiver’s planning and follow-up system, the patient’s gaming system and the connecting server system. The server back end components allow the storage of patient specific information that can be transmitted between the patient and the caregiver system for planning, monitoring and feedback purposes. The planning and follow-up system is a server system accessed through a web-based front-end, where the caregiver schedules the rehabilitation program adjusted for each individual patient and follow up on the rehabilitation progression. The patient system is the game platform developed in this project, containing 16 different games and three assessment tests. The games are based on specific motion patterns produced in collaboration with rehabilitation specialists. Motion orientation and guidance functions is implemented specifically for each exercise to provide feedback to the user of the performed motion and to ensure proper execution of the desired motion pattern.

The developed system has been tested by several people and with three real patients. The participants feedback supported the use of the game-based platform for rehabilitation as an entertaining alternative for rehabilitation at home. Further implementation work and evaluation with real patients are necessary before the product can be used for commercial purpose.

At a sophisticated lab in Barcelona, researchers are convinced that computer models based on virtual reality can help people who have suffered strokes, by providing them with better rehabilitation techniques. The claim is not just science fiction.

Like this:

Mobility Mission

Mobility Mission is an entertaining online game that addresses post-stroke mobility challenges. Stroke is a serious condition, and learning to deal with the effects of surviving a stroke can be challenging. This game will help you gain a better understanding of post-stroke mobility challenges such as spasticity, paralysis, foot drop, as well as management and treatment options you can discuss with your healthcare provider. As you travel through the four levels of the game you will learn how to improve your safety at home and acquire tips to lower your risk of falling. Your journey is waiting!

A wall, a ball, and a kid: think about it. When you were a youngster on a playground, and a wall and a ball were at hand, what would you do? If you were like most kids, you’d kick or throw that ball against the wall, moving around with the unbridled energy of youth as the ball bounced back to you, again and again.

It’s exactly that sort of natural, simple exercise that Wall Ball, a Kinect for Windows game, seeks to recreate. Or as psychologist and game developer Tino Ågren of Mixxus Studio says, “A kid in the schoolyard moves around without thinking about it being ‘exercise.’ I like games to work in the same way—you turn Wall Ball on and start moving around, getting your pulse up, just because it’s fun.”

With Wall Ball, you don’t need a playground or a physical wall or ball—just a Kinect for Xbox One sensor and a Kinect Adapter for Windows, which allows the sensor to be hooked up to a compatible Windows PC. You candownload the game itself from the Windows Store.

During game play, the Kinect sensor’s skeletal tracking follows your movements as you simulate kicking an onscreen soccer ball (you get five balls in each round). Every time one of your kicks hits the wall, you score a point—and you can earn bonus points when you hit objects that randomly appear on the wall. You also need to watch the ball as it rebounds from the wall—if you let it get past you, you’ll be penalized one ball. The game offers three levels of play: easy (or beginner), standard, and seated mode (for use by people with mobility issues).

In creating Wall Ball, Ågren used the Kinect Unity package in the Kinect for Windows SDK 2.0, which allowed him to develop the entire game in Unity. The physics simulations, which enable the skeletal tracking to accurately predict the flight of the ball, were the biggest challenge. Once he had the physics down, he knew he was on the way to creating an enjoyable way to burn off some physical energy anytime you have a few minutes. Ågren is especially happy to have made the game available through the Windows Store, which he feels is “a really good platform…a good way to reach a lot of different people.”

He hopes to see Wall Ball and Country Ramble, another of Mixxus Studio’s Kinect for Windows games, reach beyond typical video gamers. He even foresees their use in retirement homes, helping elderly folks stay physically active by playing fun games that don’t require a mastery of electronic controllers. A blessing also for those of us who are still trying to figure out our TV universal remotes!

This study surveyed 10 people with stroke for their expectations of virtual reality rehabilitation games. This study also evaluated the usability of three lowercost virtual reality rehabilitation games using a survey and House of Quality analysis. The games (kitchen, archery, and puzzle) were developed in the laboratory to encourage coordinated finger and arm movements.

Lower-cost motion tracking devices, the P5 Glove and Microsoft Kinect, were used to record the movements. People with stroke were found to desire motivating and easy-to-use games with clinical insights and encouragement from therapists. The House of Quality analysis revealed that the games should be improved by obtaining evidence for clinical effectiveness, including clinical feedback regarding improving functional abilities, adapting the games to the user’s changing functional ability, and improving usability of the motion-tracking devices.

This study reports the expectations of people with stroke for rehabilitation games and usability analysis that can help guide development of future games.

Rehabilitation is the process of training for someone in order to recover or improve their lost functions caused by neurological deficits. The upper limb rehabilitation system provides relearning of motor skills that are lost due to any neurological injuries via motor rehabilitation training. The process of motor rehabilitation is a form of motor learning via practice or experience. It requires thorough understanding and examination of neural processes involved in producing movement and learning as well as the medical aspects that may affect the central nervous system (CNS) or peripheral nervous system (PNS) in order to develop an effective treatment system. Although there are numerous rehabilitation systems which have been proposed in literatures, a low cost upper limb rehabilitation system that maximizes the functional recovery by stimulating the neural plasticity is not widely available. This is due to lack of motivation during rehabilitation training, lack of real time biofeedback information with complete database, the requirement of one to one attention between physiotherapist and patient, the technique to stimulate human neural plasticity.

Therefore, the main objective of this thesis is to develop a novel low cost rehabilitation system that helps recovery not only from loss of physical functions, but also from loss of cognitive functions to fulfill the aforementioned gaps via multimodal technologies such as augmented reality (AR), computer vision and signal processing. In order to fulfill such ambitious objectives, the following contributions have been implemented.

Firstly, since improvements in physical functions are targeted, the Rehabilitation system with Biofeedback simulation (RehaBio) is developed. The system enhances user’s motivation via game based therapeutic exercises and biofeedback. For this, AR based therapeutic games are developed to provide eye-hand coordination with inspiration in motivation via immediate audio and visual feedback. All the exercises in RehaBio are developed in a safe training environment for paralyzed patients. In addition to that, realtime biofeedback simulation is developed and integrated to serve in two ways: (1) from the patient’s point of view, the biofeedback simulation motivates the user to execute the movements since it will animate the different muscles in different colors, and (2) from the therapist’s point of view, the muscle simulations and EMG threshold level can be evaluated as patient’s muscle performance throughout the rehabilitation process.

Secondly, a new technique that stimulates the human neural plasticity is proposed. This is a virtual human arm (VHA) model that driven by proposed continuous joint angle prediction in real time based on human biological signal, Electromyogram (EMG). The VHA model simulation aims to create the illusion environment in Augmented Realitybased Illusion System (ARIS).

Finally, a complete novel upper limb rehabilitation system, Augmented Reality-based Illusion System (ARIS) is developed. The system incorporates some of the developments in RehaBio and real time VHA model to develop the illusion environment. By conducting the rehabilitation training with ARIS, user’s neural plasticity will be stimulated to reestablish the neural pathways and synapses that are able to control mobility. This is achieved via an illusion concept where an illusion scene is created in AR environment to remove the impaired real arm virtually and replace it with VHA model to be perceived as part of the user’s own body. The job of the VHA model in ARIS is when the real arm cannot perform the required task, it will take over the job of the real one and will let the user perceive the sense that the user is still able to perform the reaching movement by their own effort to the destination point. Integration with AR based therapeutic exercises and motivated immediate intrinsic and extrinsic feedback in ARIS leads to serve as a novel upper limb rehabilitation system in a clinical setting.

The usability tests and verification process of the proposed systems are conducted and provided with very encouraging results. Furthermore, the developments have been demonstrated to the clinical experts in the rehabilitation field at Port Kembla Hospital. The feedback from the professionals is very positive for both the RehaBio and ARIS systems and they have been recommended to be used in the clinical setting for paralyzed patients.

In the present study, we aimed to determine whether game-based virtual reality (VR) rehabilitation, combined with occupational therapy (OT), could improve health-related quality of life, depression, and upper extremity function. We recruited 35 patients with chronic hemiparetic stroke, and these participants were randomized into groups that underwent VR rehabilitation plus conventional OT, or the same amount of conventional OT alone, for 20 sessions over 4 weeks. Compared to baseline, the VR rehabilitation plus OT group exhibited significantly improved role limitation due to emotional problems (p=0.047). Compared to baseline, both groups also exhibited significantly improved depression (p=0.017) and upper extremity function (p=0.001), although the inter-group differences were not significant. However, a significant inter-group difference was observed for role limitation due to physical problems (p=0.031). Our results indicate that game-based VR rehabilitation has specific effects on health-related quality of life, depression, and upper extremity function among patients with chronic hemiparetic stroke.